Part 4

As all cell life and proliferation of tissue depends on the activity of the cell nuclei, much attention has been paid to the changes found in them and the behavior of the centrosomes and chromosomes, all of which is too technical for us to consider here: suffice to say, however, that several observers have demonstrated heterotypic mitosis in malignant tumors, and that histologic examination confirms what other judgment has indicated, namely, that the cancer cell differs from a normal tissue cell mainly in its aberrant action under some stimulus, probably derived from the animal fluids by which it is surrounded. Thus we come back to our original proposition, for these fluids are, of course, but a reflection of the nutrition of the body or diet, as modified by the action of the various organs, including the internal secretions; all this is influenced again by the action of the nervous system.

It is difficult to produce definite proof in regard to the influence of nervous and mental strain and shock in the production of cancer, but careful observers have long claimed that there is such an influence, and from what I have seen I am firmly convinced that in some way these conditions often do so disturb the metabolism, or otherwise operate, in such a manner that cancer results. The influence of the mind upon the body is unquestionable, as has been so fully illustrated by Tuke, and from what I have observed I cannot doubt but that the mental depression common in those with the beginning of a process which they fear might result in active cancer, has much to do with accelerating its growth; whereas, on the other hand, the hopefulness which can arise with the attempt to change the diseased process by diet and proper medication, has much to do with the favorable results which may follow in suitable cases. In the same way the constant fear of recurrence after operative removal can have its share in inducing and perpetuating the metabolic error which excites the tissues to renewed cancerous action. I know that some of you will think that this is fanciful theorizing, but many a scientific fact, in many branches of science, has been worked out from a theory which at first has seemed fanciful.

We will now consider some of the data which have been recorded in regard to the relation of the secretions and excretions of the body to cancer, including the internal secretions.

Much labor has been expended, by very many observers, upon the analysis of the _urine_ in connection with cancer, as that might be expected to reveal the metabolic changes connected with this disease. While many departures from the normal have been reported, and while under complete volumetric analysis the urine of a subject of cancer is rarely if ever that of health, it cannot be said that any definite and specific changes have been established which may not be found in those without cancer; although there have been several who have so claimed even diagnostic signs from the urine. But minute, volumetric analysis is often of great service in guiding the nutrition and medication of these patients, and gross errors are continually met with, which have the greatest bearing on the case in hand, as indicating very great metabolic disturbance: and constantly the urinary excretion will be found to be extremely deficient, both as to its quantity and its total solid elimination. In one very interesting case of cancer of the breast, in a stout, flabby lady, near 55, in private practice, the total daily quantity of the urine, measured for weeks, is always very far below the normal amount; and in spite of active medication it seems almost impossible to raise the total daily solids excreted in the urine, to more than one-half of that called for by the weight of the patient. We may now briefly consider some salient points reported in connection with the urine in cancer.

As remarked in regard to other elements in the study of the disease, it would be very desirable to have a knowledge of the urine in pre-cancerous stages of health, or ill health, and also in very early cancer, likewise after surgical operations, that we might better understand the metabolic changes which lead up to malignant disease; but unfortunately these are exceedingly few and unsatisfactory, and almost all the studies have been made in advanced cancer, and often when the disease has affected vital organs, or when by its own poison it has disturbed the workings of the economy.

Many observers agree that there is a disturbance of proteid metabolism in cancer, and dependent upon this many deviations from normal are found in the urine, some of which in turn are related to the inanition which occurs. The _urea_ is almost invariably diminished, often very greatly, as I have verified time and again in many cases.

A number of studies have been made upon the nitrogen partition in cancer by Einhorn, Kahn, and Rosenblum, also by De Bloeme, Swart, and Terwen, and others, showing an increase in colloid nitrogen, to more than double the normal amount, increased elimination of xanthin, oxyproteic acid, and urinary ammonia, together with many other changes which show that disintegration of the protein elements is very imperfect and often excessive. An interesting statement is made by Blumenthal that the oxyproteic acids are increased even in very early cancer, and independently of the size of the tumor and degree of cachexia, seemingly showing them to have some specificity for cancer, because they have not been found in other forms of malignancy. He also states that urobilin is increased in a large proportion of cases of cancer, especially when cachexia is setting in, and is a grave symptom.

Reid, who has confirmed many of these matters reported by others, says: “I have found an increase of amino-acid nitrogen in practically every case of cancer I have examined”; ... “Hence we can only infer that in cancer, the liver, while not involved in the disease, is still unable, for some reason, to perform its functions in synthetizing urea. The organ is functionally injured, no lesions having been found to explain its insufficiency”; or possibly ... “cancerous subjects form proteids which the liver is unable to deal with, so that they are excreted unchanged, or nearly so.” Degrez has made confirmatory studies along these lines, and found the nitrogen disintegration very imperfect, with increase of the ammonia fraction of nitrogen, and increased elimination of xanthin bases. He states that “the toxicity of the urine is increased apparently as the result of the presence of substances which have not been fully oxidized.”

Notable changes have also been recorded concerning the _sulphur_ elements in the urine, with a great increase in neutral (unoxidized) sulphur and a considerable excess of sulpho-cyanic acid, together with an increase in sulphates and indican showing the results of intestinal fermentation of protein elements, which also I have constantly observed.

The _chlorides_, on the other hand, are, as a rule, diminished in cancer, especially in its late stages, when there is inanition or kidney insufficiency; and probably any change in them has only a relation to the nutrition of the patients, for the chlorides come from the food and are commonly an index of the amount of nutriment absorbed. Robin finds some relation between the excretion of chlorine and nitrogen, according to the stage or degree in which the system is affected by cancer.

The _phosphates_ are known to be increased in the urine of cancer subjects, although irregularly and in an inverse ratio to the chlorides; as inanition increases there is greater autolysis of cellular structure, and the nuclei yield an excess of phosphates, which are excreted in the urine. A more or less general demineralization of the system through the urine has been observed by several, and has been recognized as a significant matter, and is of special importance when we consider what an important part minerals take in the nourishment of cell life.

While the changes which have been observed in the urine in connection with cancer are not wholly pathognomonic, but occur in connection with other diseased states of the system, so that none of them can be accepted as diagnostic of malignant disease, they all have a certain significance as indicating the metabolic changes which accompany and, as we believe, have much to do with the etiology of cancer; and, as stated before, a careful, systematic, and frequently repeated volumetrical analysis of the urine certainly assists greatly in the proper management of these cases, that is when the departures from normal are carefully studied and correctly interpreted.

The _saliva_, and its action, constitutes a very important part in the process of digestion, and consequently of metabolism and the genesis of cancer; far too little attention, however, has been paid to it practically, in ordinary life or disease, although there have been many laboratory studies and writings on the physiological action of this secretion; but I have not been able to find in literature any investigations relating to its condition in cancer. And yet the experience and writings of Mr. Fletcher and others have demonstrated wonderful results from perfect mastication and thorough insalivation, and a careful consideration of digestion must convince every one of the importance of this secretion in connection with nutrition, both in health and disease.

Our time does not permit of more than a brief allusion to the subject, but in cancer patients I have so constantly found the salivary secretion acid, and often strongly so, instead of the normal alkaline or neutral, that I cannot but believe that this condition has some bearing upon the subject which we are studying; the saliva also is apt to be acid in diabetes, which is closely allied to cancer. It is to be remembered that the saliva, which amounts in health to between one and two quarts daily, varying somewhat with the food, is not wholly for the purpose of lubricating the mouth and facilitating deglutition, but its enzymes, ptyalin and maltase, effect radical and important changes in the starchy matters consumed. It is also to be remembered that the latter cannot be acted upon by the stomach secretions, but must be passed on to the influence of the pancreatic fluid in the small intestine, in case the action of the saliva has not been effective; hence there follows delayed and imperfect digestion, faulty metabolism, deranged nutrition, and possibly tumor growth. The importance, therefore, of very slow eating, thorough mastication, and perfect insalivation cannot be too strongly insisted on, both as an element of importance in the prevention of cancer, and also as a curative measure in patients in whom the diseased process has already manifested itself.

The so-called _internal secretions_ have also been the subject of much research and speculation of late years, in regard to their influence on metabolism and the life processes of the economy, and many studies have been made concerning their connection with cancer, which cannot be long dwelt upon now; but there seems to be little doubt but that the secretions of the ductless glands in common have much to do with regulating the metabolism of the cells. We know, for instance, that disease of the pituitary body produces bone disorder, resulting in gigantism, that thyroid derangement results in myxœdema, and that disease of the supra-renal capsules gives rise to Addison’s disease, or bronzed skin; and it is not at all impossible that the derangement of secretion of one or more of these and other organs may be an element in the disordered action of certain epithelial cells, resulting in cancer. Harrower calls attention to the fact that cancer is essentially a disease of that period of life when certain of the ductless glands lose their normal function, this loss entailing related changes in the whole chain of interrelated functions of the ductless glands.

The _supra-renal_ glands by their secretion have, as we know, great vaso-constrictor influence, and their complete removal is followed by death; it is more than possible that some failure in this secretion allows the exuberant blood to supply cancerous growths. Sajous says: “Certain growths, particularly the more malignant forms of sarcoma and carcinoma, seem closely connected with adrenal insufficiency and its normal consequences,” and there have been some clinical and research data confirming such a conclusion. Sajous further says, “The adrenals, as supporters of the thyroid apparatus in the defensive process, and in sustaining oxidation, metabolism, and nutrition, seem to offer a new clew to the pathogenesis and treatment of cancer that is worthy of further inquiry.”

The _pancreas_ has been thought to have some influence in a perverted metabolism leading to cancer, Kahle stating that there is a retention of silica in that organ in cancer patients, to even double the normal amount. A treatment of cancer introduced by Beard, also strongly presented by Saleeby, by trypsin and amylopsin, the enzymes of the pancreatic fluid, excited some attention a while ago; but unfortunately no satisfactory results have thus far been obtained from this line of medication, as was fully demonstrated by Bainbridge at the New York Skin and Cancer Hospital, in one hundred cases.

The _pituitary gland_ by its secretion has undoubtedly some coordinating power, with the adrenals and thyroid, over the processes of metabolism, and a number of observers have regarded it as of importance in connection with the genesis of cancer. Little has recently reported some cases of cancer in which _pituitary extract_ with that of the pancreas has produced remarkable results.

The _thyroid_ is now recognized as playing an important part in assisting metabolism, and, like the adrenals and pituitary, its complete removal, with the parathyroids, in animals is followed by death. While the study of the hormones is still in its infancy, there seems to be no question but that the endocrinous glands act conjointly, the one influencing the other, and that together they exert a very great influence in the life processes of the body and on the behavior of its component cells. The thyroid has been shown to be one of the main factors in the management of calcium within the body, which is believed to be an element in cancer, and enhances the catabolism of toxic wastes, which are etiologic elements in this disease. Many have reported favorably on the effect of thyroid feeding in cancer, and after an experience with it in many cases I am convinced that it has been one of the means which contributed to the good results obtained. On the other hand it has been claimed by Stuart-Low that the surgical removal of the thyroid, or part of it, or ligation of the thyroid blood vessels has arrested cancer, in several cases.

_Thymus gland_ feeding has also been reported on favorably by a number of observers (Rohdenburg, Bullock, and Johnson, also Gwyer), they reporting relief of pain and improved general conditions, notably gain in weight and increased hæmoglobin in all but one of sixteen cases, though some of them died. On the other hand Ross reports most unfavorably on the administration of thymus, which he gave to some inoperable and hopeless cancer cases, in which he said that in two or three weeks the tumors had quadrupled in size and the condition of the patients was very much worse; the same occurred also when some cancer patients were given calcium salts freely. Ross makes some interesting suggestions in regard to the thymus, and its relation to calcium and magnesium; these latter are freely utilized in the growth of bone up to the age of twenty-five years, by which time the thymus gland has quite disappeared; but after this time these salts tend to have pathological relations in various tissues, and also cancer becomes frequent.

The internal secretions of the _testicles_ and _ovaries_ are also thought to have some share in metabolic processes, and observations have been made in regard to their influence in cancer. Thus Cahen reported that Beatson’s operation of castration for cancer, done first in 1896, had been repeated by many, so that Lott had reported 99 cases including his own. Of these in 23.2 per cent. the operation caused a distinct improvement in the cancer. In 15 cases the improvement persisted for a year, in 4 cases for 4½ years and in one case for over 5 years. Cahen operated on seven women with remarkable results; in two cases life was prolonged 4 and 6 years respectively. Others, however, have shown by statistics, that damage to the ovaries by disease, or their removal by operation, greatly increases the proclivity to cancer. Several writers have connected cancer with the waning of the sexual powers, and the suggestion is made by Sherrington and Copeman that in the period which antedates the cancer age, the reproductive glands, by means of internal secretions, are able to inhibit the growth of cancer.

In looking back over what has been observed in regard to the secretions, including those of ductless glands, we see that very strong evidence has accumulated to show that they have a very intimate connection with the development of cancer, as was to be expected, since they are very important factors in connection with metabolism.

We have also seen that while there has not been demonstrated any very definite and specific change in the bio-chemistry of tumors, and no specific enzymes or poison secreted by cancer cells which can communicate the disease, there is evidence that the disordered cells secrete a something which deranges the blood and ultimately tends to end life; for the blood in advancing cancer undergoes very radical, degenerative changes, some of which improve decidedly when a cancerous mass is removed surgically, but return with the regrowth of the tumor.

We have also seen that the urine manifests alterations which show a disturbed metabolism, and that the saliva has an abnormal acidity leading to disturbed amylaceous digestion.

We have further seen that there is evidence that the internal secretions of many organs, probably, through their influence on metabolism, are factors of importance in connection with the genesis and cure of cancer. Little well says, “Cancer is a disease of disordered nutrition, as a result of which cells revert to a primitive stage, which permits reproduction. The disordered nutrition is due to relative hypofunction of the ductless glands.” In later lectures we shall consider the basic causes of this deranged nutrition, which, as has been already intimated, has much to do with diet and the various elements of life which tend to induce functional and other derangements of the system, many of which are included in and influenced by what we term the advance of civilization.

LECTURE IV RELATION OF DIET TO CANCER

In our earlier lectures we saw that cancer was undoubtedly a diseased action of originally normal tissue cells, due largely to perverted metabolism, the special features of which were brought out last week. In the second lecture we studied the frequency and geographical distribution of cancer, which was found to be very different for various peoples in diverse sections of the earth, and which we saw was proportioned in a great measure according to their diet and mode of life. In this lecture we will examine into the details of these matters more particularly, and endeavor to discover their practical bearing upon the prevention and cure of cancer.

For the proper understanding of the relation of food and drink to cancer, and the satisfactory application of the principles involved, it is necessary to bear well in mind the chemistry of the body and the relation to nutrition of the various elements which contribute to form healthy and diseased tissues.

The human body is composed of some fifteen different elements, the relative proportions of which may be understood by the following table from Sherman, which represents probably as approximately correct an average as any that can be given.

COMPOSITION OF THE HUMAN BODY

_Per cent._ Oxygen, about 65 Carbon, about 18 Hydrogen, about 10 Nitrogen, about 3 Calcium, about 2 Phosphorus, about 1 Potassium, about 0.35 Sulphur, about 0.25 Sodium, about 0.15 Chlorine, about 0.15 Magnesium, about 0.05 Iron, about 0.004 Iodine } very Fluorine } minute Silicon } traces

As the actual composition of the body is changing day by day, through the activities of the system, so that it is commonly believed that after some years all the tissues are entirely renewed, the daily wear and tear, as also the material expended in heat and activity, must be supplied by the diet. For the ordinary requirements of the system, in health, the appetite serves as a guide, which should suffice in man as in wild animals, to preserve the balance of nutrition. But man has also the power to _gratify the taste_, which must be recognized in our study as distinct from the satisfying of the appetite; and the refinements of civilization have added so greatly to the temptation of wrong and over-eating and drinking, as they have to many other temptations, that it is questionable if reason, and what is often spoken of as the natural instinct for food, can be trusted in mankind.

It is to be remembered that the advance of civilization, and the facilities of transportation and cold storage, have brought from far and near an innumerable number and variety of articles for food and drink, including condiments, which bear no relation to the few simple articles formerly consumed; even the fruits which we eat are rarely ripened fully by nature, but are picked more or less green, and undergo an artificial ripening without the action of the sun, which is really akin to decay. In the combination and preparation of articles of food also, so-called civilization and refinement have made the greatest departure from the simple life of the aborigines, who are free from cancer, and with increasing ease and wealth throughout the civilized world more and more individuals are sharing in unnecessary and often harmful indulgences, more and more freely: and this is especially true of animal food, the consumption of which has increased so greatly. Many other elements likewise enter into the matter of the digestibility and consequent nutritive power of food and drink; such are nervous conditions, rapid eating, imperfect mastication and insalivation, heat and cold, character of the air breathed, micro-organisms, etc., and all the various causes which may derange the action of the digestive organs and so prevent the perfect metabolism between nutrient material and the cells of the body, as I tried to show you in some former lectures.

As is well known, the nutrition of man is supplied by the organic substances, protein, carbohydrates, and fat; these are found in various combinations in animal and vegetarian foods, and as a rule contain also much of the inorganic or mineral substances necessary for the system; all of these with water, and its salts, and oxygen, supplied by the lungs, unite, through anabolism and catabolism, to build and maintain the human body in health.